Objective:To study the effect of angiopoietin-1(Ang-1)and tyrosine kinase receptor 2(Tie2)inhibitor on glucose transportation in the human umbilical vein endothelial cells(HUVECs)cultured under high glucose conditions,and to clarify its mechanism.Methods:The HUVECs were cultured in high glucose(30 mmol·L?1)in vitro and treated with 0,200,500,1 000,and 2 000 μg·L?1 Ang-1 and 0,2 500,5 000,and 7 500 nmol·L?1 Tie2 inhibitor;cell counting kit-8(CCK-8)method was used to detect the cell activity to screen the optimal concentrations of Ang-1 and Tie2 inhibitor.Glucose kit was used to detect the glucose level in the supernatant of the HUVECs after Ang-1 intervention.The HUVECs were randomly divided into blank control group(NG group),high glucose group(HG group),HG+Tie2 inhibitor group(HG+In-Tie2 group),HG+Ang-1 group,HG+Ang-1+Tie2 inhibitor group(HG+Ang-1+In-Tie2 group),and HG+Ang-1+phosphatidylinositol 3-kinase(PI3K)inhibitor group(HG+Ang-1+LY294002 group).5-Ethynyl-2'-deoxyuridine(EdU)method was used to detect the proliferation activities of the cells in various groups;YO-PRO-1/PI method was used to detect the apoptotic rates of the cells in various groups;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression levels of Ang-1 mRNA and Tie2 mRNA in the cells in various groups;Western blotting method was used to detect the expression levels of Tie2,glucose transporter 1(GLUT1),and glucose transporter 4(GLUT4)proteins and the ratios of phosphorylated PI3K(p-PI3K)/PI3K and phosphorylated protein kinase B(p-AKT)/AKT in the cells in various groups.Results:The CCK-8 assay results showed that compared with 0 μg·L?1 Ang-1 group,the activity of the HUVECs was significantly increased after treated with 200 μg·L?1 Ang-1 for 48 h(P<0.01);compared with 0 nmol·L?1 Tie2 inhibitor group,the activity of the HUVECs was significantly decreased after treated with 2 500、5 000 and 7 500 nmol·L?1 Tie2 inhibitor(P<0.01);the optimal concentrations of Ang-1 and Tie2 inhibitor were 200 μg·L?1 and 2 500 nmol·L?1,respectively.Compared with NG group,the glucose level in the supernatant of the HUVECs in HG group was significantly increased(P<0.01);compared with HG group,the glucose level in the supernatant of the HUVECs in Ang-1 group was significantly decreased(P<0.01).The EdU assay results showed that compared with NG group,the proliferation activity of the HUVECs in HG group was significantly decreased(P<0.01);compared with HG group,the proliferation activity of the HUVECs in HG+In-Tie2 group was significantly decreased(P<0.01),and the proliferation activity of the HUVECs in HG+Ang-1 group was significantly increased(P<0.01);compared with HG+Ang-1 group,the proliferation activities of the HUVECs in HG+Ang-1+In-Tie2 group and HG+Ang-1+LY294002 group were significantly decreased(P<0.01).The YO-PRO-1/PI assay results showed that compared with NG group,the apoptotic rate of the HUVECs in HG group was significantly increased(P<0.01);compared with HG group,the apoptotic rate of the HUVECs in HG+In-Tie2 group was significantly increased(P<0.01),and the apoptotic rate of the HUVECs in HG+Ang-1 group was significantly decreased(P<0.01);compared with HG+Ang-1 group,the apoptotic rates of the HUVECs in HG+Ang-1+In-Tie2 group and HG+Ang-1+LY294002 group were significantly increased(P<0.01).The RT-qPCR results showed that compared with NG group,the expression levels of Ang-1 mRNA and Tie2 mRNA in the HUVECs in HG group and HG+In-Tie2 group were significantly decreased(P<0.01);compared with HG group,the expression levels of Ang-1 mRNA and Tie2 mRNA in HG+In-Tie2 group were significantly decreased(P<0.01),and the expression levels of Ang-1 mRNA and Tie2 mRNA in the HUVECs in HG+Ang-1 group were significantly increased(P<0.05);compared with HG+Ang-1 group,the expression levels of Ang-1 mRNA and Tie2 mRNA in the HUVECs in HG+Ang-1+In-Tie2 group and HG+Ang-1+LY294002 group were significantly decreased(P<0.05 or P<0.01).The Western blotting results showed that compared with NG group,the expression level of Tie2 protein in the HUVECs in HG group was significantly decreased(P<0.01),and the expression levels of GLUT1 and GLUT4 proteins were significantly increased(P<0.01);compared with HG group,the expression levels of Tie2,GLUT1,and GLUT4 proteins in the HUVECs in HG+In-Tie2 group were significantly decreased(P<0.01),the expression level of Tie2 protein in the HUVECs in HG+Ang-1 group was significantly increased(P<0.01),and the expression levels of GLUT1 and GLUT4 proteins were significantly decreased(P<0.01);compared with HG+Ang-1 group,the expression levels of Tie2,GLUT1,and GLUT4 proteins in the HUVECs in HG+Ang-1+In-Tie2 group and HG+Ang-1+LY294002 group were significantly decreased(P<0.01).Compared with NG group,the p-PI3K/PI3K and p-AKT/AKT ratios in the HUVECs in HG group were significantly increased(P<0.01);compared with HG group,the p-PI3K/PI3K and p-AKT/AKT ratios in the HUVECs in HG+In-Tie2 group were significantly decreased(P<0.01),and the p-PI3K/PI3K and p-AKT/AKT ratios in the HUVECs in HG+Ang-1 group were significantly decreased(P<0.01);compared with HG+Ang-1 group,the p-PI3K/PI3K and p-AKT/AKT ratios in the HUVECs in HG+Ang-1+In-Tie2 group and HG+Ang-1+LY294002 group were significantly decreased(P<0.01).Conclusion:Ang-1 down-regulates the expressions of GLUT1 and GLUT4 in the HUVECs cultured under high glucose conditions;the binding of Ang-1 to Tie2 may down-regulate GLUT1 and GLUT4 via the PI3K/AKT signaling pathway to participate in the glucose transportation in the HUVECs cultured under high glucose conditions.

Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective To explore the types of symptom clusters in patients with bladder instillation and identify the core symptoms through symptom network analysis,and to provide evidence for symptom management of the patients.Methods Convenience sampling was used to select 226 patients with bladder instillation for bladder cancer at a Tier-IIIA hospital in Guiyang from March 2023 to July 2024.Data were collected through review of medical record,general information questionnaires and symptom assessment questionnaires specific to the patients with bladder instillation.Exploratory factor analysis was used to extract symptom clusters,and symptom relationships were analysed using R language for network layout and centrality calculations.Results A total of 223 patients with bladder cancer completed the survey.Four symptom clusters were identified,namely the urinary system symptom cluster,digestive system symptom cluster,somatic symptom cluster and psychological symptom cluster,with a cumulative variance contribution rate of 66.038%.The symptom network analysis showed strong associations between dysuria and urethral pain during catheterisation,incomplete emptying and dysuria,as well as distress and poor sleep quality.In terms of centrality indicators,the top three symptoms by strength were dysuria(rS=2.26),incomplete emptying(rS=0.99)and poor sleep quality(rS=0.90).Of the expected impacts,the top three were dysuria(rE=2.09),poor sleep quality(rE=1.34)and frequency of urinary(rE=0.55).Regarding the closeness centrality,the top three were dysuria(rC=2.23),incomplete emptying(rC=0.64)and poor sleep quality(rC=0.54).Dysuria had the highest strength,expected impact and closeness centrality,indicating the dysuria was the core symptom in the patients with bladder cancer.Conclusion For the patients with bladder instillation experience,multiple and interconnected symptoms appear at the same time and together they form a symptom clusters,of which the pain in urination is the core symptom.Medical staff should consider symptom prevalence and core symptoms and to develop the targeted and precise management strategies for targeted nursing.

Background Occupational disease diagnosis appraisal is an appeal procedure initiated when a party disagrees with the occupational disease diagnosis conclusion. It is a legal procedure to safeguard the health rights of employees and the legitimate rights and interests of employers. Objective To analyze the data of occupational disease diagnosis appraisal in Shanghai, identify existing problems, and provide suggestions for improving. Methods Statistical analysis was conducted on basic situation, characteristics of workers and employers, disease classification, and consistency between diagnosis and appraisal conclusions of all occupational disease diagnosis appraisal cases from 2012 to 2024. All diagnosis conclusions were named in accordance with the Classified Catalogue of Occupational Diseases included employers were classified according to the Measures for the Statistical Classification of Large, Medium, Small and Micro Enterprises" and the Notice on Adjusting the Provisions for Classifying Enterprise Registration Types; industry classification followed the Industrial Classification for National Economic Activities (GB/T 4754-2017). Results From 2012 to 2024, a total of 260 cases of occupational diseases diagnosis appraisal were closed. The main diagnosis were 138 cases of ear, nose, throat, and oral diseases (53.1%), chemical poisoning (18.8%), and pneumoconiosis and other respiratory diseases (16.2%). The proportion of ear, nose, throat, and oral diseases gradually increased (2022 excluded). The incidence of annual municipal and provincial cases decreased by 76.3% and 85.0% respectively (2024 vs 2012). The consistency rate of conclusions between appraisal and diagnosis gradually increased. The total consistency rates between final appraisals and diagnostic conclusions were 81.5%, and 79.7%, 87.8%, 100.0%, 85.0% for ear, nose, throat, and oral diseases, chemical poisoning, and pneumoconiosis and other respiratory system diseases, respectively. Specifically, the consistency rates were 80.1% and 80.0% for noise-induced deafness and chronic benzene poisoning. In terms of inconsistency reasons, "inconsistent interpretation of standards and excessive discretion in standard application" accounted for 43.8%, followed by "failure to correctly apply standards" (31.3%) and and "discrepancies in occupational exposure history recognition" (15.6%). Conclusion The revisions and improvements of the legal system for occupational disease diagnosis appraisal have played a positive role in improving the consistency of conclusions between appraisal and diagnosis of occupational diseases in Shanghai. It is suggested to further strengthening the publicity and training of occupational disease diagnosis standards to improve the quality of occupational disease diagnosis.

Objective:To explore and evaluate the effectiveness of integrating standardized patient cases with simulation-based teaching in internship teaching in the department of obstetrics and gynecology.Methods:This study enrolled 60 interns from the Department of Obstetrics and Gynecology at Hangzhou First People's Hospital between January 2022 and December 2023. Participants were randomly assigned using a random number table into a control group (simulator training) and an experimental group (simulated standardized patient consultation integrated with simulation training). Simulation-based teaching was performed for seven skill modules. After training, participants underwent both skill assessments and questionnaire surveys. Skill assessment scores, professional competencies, and self-evaluation outcomes were compared between the two groups.Results:In skill assessments for delivery [(90.50±5.51) vs. (84.90±5.30)], I° perineal laceration repair [(91.98±6.87) vs. (84.18±10.24)], abortion[(90.43±6.79) vs. (84.10±5.36)], and diagnostic curettage [(92.57±8.19) vs. (85.80±8.61)], the experimental group scored significantly higher than the control group ( P<0.05). The experimental group showed higher scores in demonstrating empathy [53.33% (16/30) vs. 23.33% (7/30), P<0.05] and prioritizing doctor-patient communication [96.67% (29/30) vs. 46.67% (14/30), P<0.01]. Additionally, the experimental group reported higher scores in course satisfaction [(9.48±0.50) vs. (9.02±0.45)], performance self-assessment [(9.17±0.35) vs. (8.65±0.27)], engagement during simulation-based training [(9.62±0.43) vs. (8.43±1.21)], and learning gains [(9.53±0.87) vs. (8.88±1.02)]. Conclusions:Compared to simulation-based teaching alone, the integration of standardized patient cases can improve learning outcomes for complex and comprehensive skill modules and contribute to the development of professional competencies.

Objective Analyze the epidemiological characteristics of respiratory virus infections in Kunming area during 2023-2024,and explore the detection rates of different virus types and their distribution patterns across different time periods and age groups.Methods A total of 10354 nasopharyngeal swab or sputum samples were retrospectively collected from patients with acute respiratory infections who visited the Third People's Hospital of Kunming City between March 2023 and June 2024.Multiple pathogens were detected using real-time fluorescent quantitative polymerase chain reaction(RT-qPCR)technology.A retrospective analysis was then conducted on the clinical laboratory detection results,statistically analyzing the overall detection rates of various respiratory viruses,multiple infection phenomena,gender differences,age distribution,seasonal variations,infection site differences,and monthly infection situations.Results Among the 10354 patient respiratory samples tested,3368 pathogen infections were detected,with a detection rate of 32.53%(3368/10354).204 patients presented with mixed infections of≥2 pathogens,with a mixed detection rate of 6.06%(204/3368).The single detection rate for females was significantly higher than males(P<0.001),and the multiple infection detection rate for males is significantly higher than females(P<0.05),indicating that males may have a higher risk of concurrent infections.Among different age groups,the virus detection rate was highest in the 5-18 years age group at 55.87%.Significant differences were observed in the detection rates of FluA,FluB,and SIV-H3 across different disease types(P<0.05).In March 2023,the detection rate was highest at 54.27%(5619/10354),with Influenza A virus(FluA)and seasonal influenza H3 subtype(SIV-H3)being the most detected pathogens.Conclusion In acute respiratory infection(ARI)cases in the Kunming area,FluA,FluB,and SIV-H3 were the primary viral pathogens,with the region's viral epidemic characteristics closely related to patient age stages,seasonal changes,and infection site factors.

Objective To explore the types of symptom clusters in patients with bladder instillation and identify the core symptoms through symptom network analysis,and to provide evidence for symptom management of the patients.Methods Convenience sampling was used to select 226 patients with bladder instillation for bladder cancer at a Tier-IIIA hospital in Guiyang from March 2023 to July 2024.Data were collected through review of medical record,general information questionnaires and symptom assessment questionnaires specific to the patients with bladder instillation.Exploratory factor analysis was used to extract symptom clusters,and symptom relationships were analysed using R language for network layout and centrality calculations.Results A total of 223 patients with bladder cancer completed the survey.Four symptom clusters were identified,namely the urinary system symptom cluster,digestive system symptom cluster,somatic symptom cluster and psychological symptom cluster,with a cumulative variance contribution rate of 66.038%.The symptom network analysis showed strong associations between dysuria and urethral pain during catheterisation,incomplete emptying and dysuria,as well as distress and poor sleep quality.In terms of centrality indicators,the top three symptoms by strength were dysuria(rS=2.26),incomplete emptying(rS=0.99)and poor sleep quality(rS=0.90).Of the expected impacts,the top three were dysuria(rE=2.09),poor sleep quality(rE=1.34)and frequency of urinary(rE=0.55).Regarding the closeness centrality,the top three were dysuria(rC=2.23),incomplete emptying(rC=0.64)and poor sleep quality(rC=0.54).Dysuria had the highest strength,expected impact and closeness centrality,indicating the dysuria was the core symptom in the patients with bladder cancer.Conclusion For the patients with bladder instillation experience,multiple and interconnected symptoms appear at the same time and together they form a symptom clusters,of which the pain in urination is the core symptom.Medical staff should consider symptom prevalence and core symptoms and to develop the targeted and precise management strategies for targeted nursing.

Objective:To explore and evaluate the effectiveness of integrating standardized patient cases with simulation-based teaching in internship teaching in the department of obstetrics and gynecology.Methods:This study enrolled 60 interns from the Department of Obstetrics and Gynecology at Hangzhou First People's Hospital between January 2022 and December 2023. Participants were randomly assigned using a random number table into a control group (simulator training) and an experimental group (simulated standardized patient consultation integrated with simulation training). Simulation-based teaching was performed for seven skill modules. After training, participants underwent both skill assessments and questionnaire surveys. Skill assessment scores, professional competencies, and self-evaluation outcomes were compared between the two groups.Results:In skill assessments for delivery [(90.50±5.51) vs. (84.90±5.30)], I° perineal laceration repair [(91.98±6.87) vs. (84.18±10.24)], abortion[(90.43±6.79) vs. (84.10±5.36)], and diagnostic curettage [(92.57±8.19) vs. (85.80±8.61)], the experimental group scored significantly higher than the control group ( P<0.05). The experimental group showed higher scores in demonstrating empathy [53.33% (16/30) vs. 23.33% (7/30), P<0.05] and prioritizing doctor-patient communication [96.67% (29/30) vs. 46.67% (14/30), P<0.01]. Additionally, the experimental group reported higher scores in course satisfaction [(9.48±0.50) vs. (9.02±0.45)], performance self-assessment [(9.17±0.35) vs. (8.65±0.27)], engagement during simulation-based training [(9.62±0.43) vs. (8.43±1.21)], and learning gains [(9.53±0.87) vs. (8.88±1.02)]. Conclusions:Compared to simulation-based teaching alone, the integration of standardized patient cases can improve learning outcomes for complex and comprehensive skill modules and contribute to the development of professional competencies.

In order to investigate the clinical manifestations and laboratory findings associated with brucellosis for the purpose of facilitating prompt clinical diagnosis and effective treatment, as well as to offer a laboratory reference for the prevention of brucellosis outbreaks. In this study, a retrospective cohort design was employed to gather epidemiological characteristics, clinical symptoms, and associated laboratory data from 391 patients diagnosed with bacterial culture-positive brucellosis at the People′s Hospital of Ningxia Hui Autonomous Region between 2019 and 2023. The patients were categorized into four age groups, with each group representing a 20 years age interval. Statistical analyses were conducted to examine the differences between these age groups using R version 4.3.2 and SPSS version 24.0 software. The results showed that among the 391 cases of brucellosis patients, fever (241 cases, 61.64%), lumbar and leg joint pain (225 cases, 57.54%), abnormal liver function (124 cases, 31.71%), spleen enlargement (78 cases, 19.95%), and cholecystitis (75 cases, 19.18%) were identified as the most prevalent clinical symptoms. Furthermore, the presence of clinical symptoms such as fever, lumbar and leg joint pain, abdominal pain and distension, headache, dizziness, rash, and complications including abnormal liver function, cholecystitis, spleen enlargement, exhibited statistical significance across four distinct age groups ( P<0.05). The initial presentation of acute fever and rash was more pronounced in the pediatric cohort. In contrast, the youth group exhibited a higher prevalence of acute fever, liver function abnormalities, dizziness, headache, and splenomegaly. Furthermore, the strong-age group and the older age group more frequently experienced lumbar and leg joint pain, and symptoms related to the liver, gallbladder, spleen, and digestive system. In terms of laboratory examination, the rates of decreased white blood cell count (WBC), red blood cell count (RBC) and platelet count (PLT) were 18.91% (73 cases), 28.94% (112 cases) and 22.34% (86 cases), respectively. C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total biluric acid (TBA), adenosine deaminase (ADA), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), procalcitonin (PCT), and D-Dimer (D-Dimer). The proportion of patients with elevated quantitative test results was 88.56% (271 cases), 50.90% (197 cases), 52.20% (202 cases), 23.82% (91 cases), 75.72% (290 cases), 23.06% (89 cases), 40.89% (157 cases), 68.34% (218 cases) and 73.33% (209 cases), respectively. Among them, the quantitative detection results of CPR, ALP and D-Dimer had statistical significance among the 4 age groups ( χ2=16.366,28.089,7.880, P<0.05). Abnormally elevated laboratory parameters, including C-reactive protein (CRP), alkaline phosphatase (ALP), and D-dimer, were more pronounced in middle-aged and older cohorts, with a positive correlation to advancing age. Among the 391 brucella culture positive specimens, the top three departments with the highest number of isolations were infectious disease (52.4%, 204 cases), emergency (9.5%, 37 cases) and orthopedics (8.4%, 33 cases). In conclusion, the clinical manifestations of brucellosis are multifaceted and heterogeneous, frequently involving multiple organ systems, and the laboratory test results exhibit considerable variability. These findings indicate that clinicians should integrate clinical features of brucellosis with laboratory test results, considering the patient′s age group, to enhance diagnostic accuracy and triage efficiency in suspected cases. Improving relevant diagnostic examinations can thereby aid in the effective control and prevention of the disease.